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The primary goal of the National Association of Boards of Pharmacy (NABP) is to protect public health by regulating the practice of pharmacy. Members include all U.S. states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands, nine Canadian provinces, two Australian states, and New Zealand.

When we had examination breaches, our recruiters, colleges and employers put significant pressure on our board of pharmacy members. They said, “You can’t do this because it’s going to cut down access;”“People won’t have vital services;” and “Pharmacy services are needed, so you need to back off and rethink your decision.”

We have looked at security breaches from all perspectives, and we are doing what’s in the best interest of the patient in a fair and unbiased manner. Many of the candidates that were involved in these compromises and breaches are hyper-performing candidates that will pass no matter what. Other candidates may not be that well prepared or that knowledgeable; they are going to fail the test no matter what.

Suppose a family member is involved in a serious accident and is rushed to the hospital for emergency surgery and the surgeon is one that compromised on his examination or was on the borderline and shouldn’t have passed that exam. Now he is going to perform surgery on a member of your family.Perhaps people don’t value physical therapists or pharmacists to the same level as surgeons, but it’s the same concept and the same responsibility.

We have had to designate certain countries and certain schools that are no longer qualified to take our examinations because of breaches and compromise and lack of security.

NABP accredits durable medical equipment suppliers and pharmacies. We accredited more than 30,000pharmacies last year. We accredit internet pharmacies and wholesalers on behalf of the state. We have surveyors and inspectors doing inspections in all pharmacies that we accredit throughout the United States. We also manage the Association of State Boards and as well as accreditation programs for the states. So the scope of our association extends beyond testing. We have all disciplinary information on all pharmacists, and we share that information with the state.

Our organization has been around since 1904 and we know we have exam programs that have been compromised. Any organization that has an exam program and doesn’t believe it has been compromised is not seeing reality. It is an ongoing battle with a small percentage of people in all of our professions and occupations and no profession or occupation is exempt - including the FBI.

We have compromised our foreign exam. We went with paper and pencil, but there’s really no way to maintain security anymore. We had a candidate that took the examination recently and spent five seconds on every question and answered C for every question. So we suspect the candidate had some sort of copying device in his glasses. He was just photocopying the items or taking pictures of the items on the computer screen.

We went to a store to ask about copying devices. Without hesitation, the clerk said there were two items I could buy. The first one would work in almost any testing environment. It was what looked like a cigarette lighter, but was actually a camera. The other is regular-looking eye glasses that had a camera in the upper right-hand corner and a controller device where one could take a photograph of every screen or every page. The clerk would have been perfectly happy to sell me as many of these devices as I wanted. So we have to look at having new items on every test, which is going to drive up the exam cost and limit the times we can administer the exam.

At the moment, we are involved in litigation against the Board of Regents of the University of Georgia in regard to faculty members organizing efforts with students to compromise our examinations. We first became aware of these faculty members’ efforts in 1994/1995. We worked with the University of Georgia to shut that down. They (individual faculty members and the university) signed a contract with us to not do this again. In 2006, the activity was once again widespread. We obtained a court order to go into a professor’s home and office to confiscate all his files, computers and any materials related to this operation. The compromise was so significant we had to shut down the national licensing exam for a number of months.

The individual was regarded as a deity for his review program. He was being paid $1,000 a day for this service which compromised more than 600 of our items. We now have litigation against the University of Georgia for copyright trademark infringement. We also have gathered a list of students who used their email addresses concerning the data, and we are going to take action against them either civilly or criminally, whichever is relevant.

Our board of directors is composed of 10 people elected by our members. We told them we cannot administer a valid examination because of the compromise and the board voted to shut down the examination. We informed the states, which said, in essence, “Please do what you need to do because we want to make sure it is a valid exam.”

We also had situations where we noted some problems with particular schools in other countries. We did the forensic analysis and were able to identify certain schools in certain countries. Once again, our members stood behind us in support. We never received a single lawsuit from any individual candidate or any recruiter.

We do not accept any scores for any tests outside the United States for two reasons. We cannot guarantee the security in those other countries despite the assurance that are given to us, and we wantto be able to take action against candidates who cheat. We can then go after those individuals or those institutions in the United States without having to go through a very rigorous, unfulfilling and expensive process to try to deal with another government.

We have also invalidated scores of students from the U.S. in situations where the exam was compromised. We did the forensic data analysis. Only candidates for which there was no evidence to validate cancellation were allowed to keep the scores. If there was any question about the score, we invalidated it. Is it possible that some students not involved had scores invalidated? I am sure it was possible, but our choice was to be on the side of the patient and protection of public health.

Our stand is that the integrity of the exam and integrity of the process is more important than some of the pressure that we received to do otherwise.

Carmen Catizone, MS, RPh, DPh, is Executive Director/Secretary of the National Association of Boards ofPharmacy